230 



FASCIA. 



The arrangement to which we allude in the 

 fascia of the neck may be satisfactorily traced 

 from the median line on the anterior surface of 

 the neck, proceeding outwards on each side. 

 On the median line the fasciae of opposite sides 

 are intimately united so as to form a dense line, 

 called by some anatomists linea alba cervicalis; 

 thence on each side the fascia divides into 

 laminae, investing the sterno-hyoid and thyroid 

 muscles, the carotid artery and jugular vein, 

 the sterno-mastoid, and other muscles; and 

 thus anatomists come to describe a superficial 

 and a deep layer of the cervical fascia; the 

 former being continuous with the superficial 

 fascia covering the muscles on the anterior 

 part of the thorax, the latter, intimately con- 

 nected with all the deep-seated structures in 

 the neck, may be traced outwards behind the 

 sterno-mastoid muscle, along the posterior edge 

 of which it becomes again united with the su- 

 perficial layer ; the fascia, thus re-constructed, 

 passes through the triangular space which in- 

 tervenes between the muscle last-named and 

 the trapezius, and may be traced over that 

 muscle to become continuous with the superfi- 

 cial fascia on the back. It is the deep layer 

 of this fascia which was described by Godman 

 of Philadelphia* as passing downwards behind 

 the sternum to be continuous with the fibrous 

 pericardium. This description has been sub- 

 sequently confirmed by more than one anato- 

 mist in France, although denied by Cru- 

 veilhier, and in this country by Sir Astley 

 Cooper, f who has described it in the same 

 manner, apparently without being acquainted 

 with the previously recorded statements of the 

 anatomists above referred to ; I may add that 

 I have myself in many instances proved the 

 accuracy of Godman's description. The cer- 

 vical fascia is continuous superiorly with the 

 superficial fascia on the face; and inferiorly, 

 besides tracing it into the pectoral region, we 

 can follow it over the shoulder into the arm. 

 The cervical fascia, in a great part of its extent, 

 is not, as the superficial fascia elsewhere, in 

 intimate connexion with the subcutaneous cel- 

 lular tissue, but is separated from it on each 

 side of the neck by the fibres of the platysma 

 myoides. From this brief account of the cervi- 

 cal fascia, (we refer for the more particular 

 description to the article on the surgical ana- 

 tomy of the NECK,) we learn one characteristic 

 of the superficial fascia, namely, its continuity 

 all over the body. 



The superficial fascia of the abdomen has 

 attracted the attention of anatomists and sur- 

 geons from its connexion with all herniary 

 tumours in that region. In its arrangement it is 

 much less complex than the cervical fascia, 

 being a uniform membranous expansion spread 

 over the superficial muscular and aponeurotic 

 structures of the abomen, continuous on either 

 side and posteriorly with the superficial fascia 

 of the lumbar regions, and inferiorly with that 

 of the inferior extremities. See the description 

 of it in the article ABDOMEN. 



* Anatomical Investigations, Philadelph. 1824. 

 t On the thymus gland. 



The superficial fascia of the limbs is com- 

 pletely confounded with the subcutaneous cel- 

 lular tissue, and wants that condensation by 

 which on the trunk generally, but particularly 

 in the neck and abdomen, it is distinguished. 



There can be no doubt that the superficial 

 fascia is no more than condensed cellular mem- 

 brane, and its variety of appearance in different 

 regions depends in a great measure upon pecu- 

 liarities in the motions and arrangement of the 

 parts contained in those regions, e.g. wherever 

 the muscles of a part are in very frequent ac- 

 tion, and at the same time the fascia is com- 

 pressed between the integument and the mus- 

 cles, it suffers condensation ; this is conspicuous 

 in the abdomen, where there is almost incessant 

 muscular action in consequence of the respi- 

 ratory movements, and where the weight of the 

 viscera, thrown forwards in the erect posture, 

 occasions a considerable pressure upon the an- 

 terior and lateral portions of the abdominal 

 parietes. The deposition of adeps to any great 

 extent is unfavourable to the existence of a 

 distinct fascia superficial is, which is thereby, as 

 it were, decomposed, and hence this fascia is 

 not distinct from the subcutaneous cellular 

 tissue in those regions where, either habitually 

 or preternaturally, this substance is largely de- 

 posited. 



The superficial fascia is identified with the 

 subcutaneous cellular membrane in the cranial 

 regions, a circumstance which seems attributa- 

 ble to the firm adhesion of the aponeurotic ex- 

 pansion of the occipito-frontalis muscle to the 

 subcutaneous tissue, and also the cutaneous 

 insertion of other muscles ; to a similar cause 

 we may ascribe the indistinctness of this fascia 

 in the face also, as likewise to the great depo- 

 sition of fat in some parts of this region. In 

 the pectoral region it is attenuated, and is 

 more intimately connected with the proper 

 cellular covering of the great muscles than 

 with the subcutaneous cellular tissue. 



Where the superficial fascia has suffered 

 condensation to a considerable extent, and 

 there is a complete absence of adipose sub- 

 stance, it assumes an appearance which has 

 given rise to the designation " fibro-cellular," 

 in consequence of the existence of thick, white, 

 and opaque bundles intersecting the membrane 

 in various directions; these bundles seem to 

 be produced by the close application of the 

 walls of the cells to each other, and the conse- 

 quent obliteration of their cavities. This, how- 

 ever, I believe is the nearest approach that the 

 superficial fascia makes to fibrous membrane ; 

 and I am strongly disposed to question the 

 accuracy of Velpeau's assertion, that it is some- 

 times transformed into the yellow fibrous or into 

 muscular tissue. The elastic abdominal ex- 

 pansion, described by Girard, is certainly not 

 a conversion of the superficial fascia, but of 

 the muscular aponeurosis. 



Among the cellular fasciae, Velpeau* de- 

 scribes a layer of cellular membrane, pretty 

 uniform in its characters, and in some localities 

 of great practical importance, and gives it the 



* Anat. Chiiurg. t. i. p. 42. 



